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Delayed emergence of fetal behaviour in type-1 diabetic women
Insights
Maternal type-1 diabetes can delay fetal nervous system development, impacting motor skills. However, when growth is normalized, movement patterns emerge similarly to healthy pregnancies, suggesting a parallel delay.
Area of Science:
- Perinatology
- Developmental Neuroscience
- Endocrinology
Background:
- Maternal type-1 diabetes is linked to early fetal growth delay and abnormal embryogenesis.
- Congenital malformations, particularly affecting the nervous system, are common in infants of diabetic mothers.
- A potential common mechanism underlying growth delay and nervous system development issues requires investigation.
Purpose of the Study:
- To investigate specific delays in neural activity development in fetuses of mothers with type-1 diabetes.
- To determine if functional motor development, assessed via fetal movement patterns, is delayed.
- To compare the emergence of fetal movements in well-controlled diabetic pregnancies with uncomplicated pregnancies.
Main Methods:
- Weekly 1-hour real-time ultrasound observations of fetal movement patterns in ten women with type-1 diabetes, starting at or before 8 weeks gestation.
- Continuous subcutaneous insulin infusion for tight metabolic control in all participants, with pre-conception treatment in six.
- Comparison of movement pattern emergence timing and crown-rump length-adjusted timing with a control group of uncomplicated pregnancies.
Main Results:
- A delay of 1-2 weeks in the appearance of most fetal movement patterns within the first 12 weeks of gestation was observed in the diabetic group.
- Breathing movements emerged at the same gestational age as in the control group.
- When plotted against crown-rump length, the emergence of most fetal movement patterns occurred at similar times as in controls, indicating a delay parallel to growth.
Conclusions:
- Well-controlled type-1 diabetes during pregnancy is associated with a delay in the functional motor development of the embryonic and fetal nervous system.
- This developmental delay is not highly specific and generally parallels fetal growth.
- Breathing movements appear relatively early in development compared to overall fetal growth in this cohort.
Abstract:
In pregnancies complicated by maternal type-1 diabetes early fetal growth delay is common and it is suggested that there might be a common mechanism behind this growth delay and the induction of abnormal embryogenesis. As some of the most frequent congenital malformations involve the nervous system, the following study was performed in order to determine whether there is a specific delay in development of neural activity in these embryos and fetuses. In ten women with type-1 diabetes the emergence of specific fetal movement patterns, which are an expression of the functional motor development of the nervous system, was studied weekly by 1 h real-time ultrasound observations, starting at or before 8 weeks of gestation. Data were compared with those obtained in uncomplicated pregnancies. In all women a tight metabolic control was achieved with continuous subcutaneous insulin infusion. In six patients this treatment was started before conception. In all but one of the movement patterns emerging in the first 12 weeks of gestation a delay of 1-2 weeks was found in their first appearance. Only breathing movements were observed for the first time at the same gestational age as in the control group. Plotted according to crown-rump length the emergence of fetal movement patterns occurred, however, almost at the same time as in the control group. It is concluded, that in well controlled diabetic pregnancy there is a delay in functional motor development of the embryonic and fetal nervous system; this delay is not very specific but mostly parallels that of growth; breathing movements emerge relatively early as compared to growth.